BACKGROUND: Obesity and metabolic syndrome are related to cardiovascular events. However, the association different metabolic phenotypes and obesity with cardiovascular events among young adults aged 18-45 with acute coronary syndrome (ACS) remains unclear. The study aimed to investigate the prognosis of patients aged 18-45 years with ACS based on their metabolic phenotype. METHODS: This study included 1787 patients with ACS ≤ 45 years of age who underwent coronary angiography. Patients were divided into four groups according to metabolic phenotype: metabolically healthy non-obesity (MHN)
MHO
metabolically unhealthy non-obesity (MUN)
and metabolically unhealthy obesity (MUO). The primary outcome was major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke, or unplanned revascularization. RESULTS: Among 1787 patients with ACS, the median age was 41.6 years, 1675 (93.7%) were men, 1111 (62.2%) had obesity, and 659 (36.9%) were classified as MHO. During a median 65 months follow-up, 404 MACE occurred. Multivariate analysis showed that MHO was correlated with a decreased risk of MACE, while MUN significantly increased the risk compared to MHN (MHO: HR 0.69, 95%CI 0.52-0.92, P = 0.011
MUN: HR 1.47, 95%CI 1.07-2.02 P = 0.018). Moreover, restricted cubic spline analysis revealed a linear relationship between body mass index (BMI) and the incidence of MACE (P CONCLUSIONS: MHO was correlated with a decreased risk of MACE, while MUN significantly increased the risk compared to MHN. Moreover, there was a linear relationship between BMI and the incidence of MACE.